Use of antibiotics in penetrating craniocerebral injuries

Henry Shrapnel invented an antipersonnel weapon capable of defragmenting with the explosion of charge. Modern grenades or improvised explosive devices may be seen as an evolution of Shrapnel's ammunition. Starting by analyzing the ballistics of these weapons, it is possible to understand the historical evolution of the management of skull fractures and penetrating brain injuries (PBIs). A circular crack line with a splinter at the center, depressed in bone, was a characteristic feature of fractures due to Shrapnel's bullet...

BACKGROUND/AIMS: Infants are especially at risk for intracranial injuries from dog bites due to their small stature and thin skull. Only 21 case reports have been published in the literature. We aim to add knowledge and treatment recommendations based on a more substantial sample. METHODS: Ten pediatric patients with a penetrating skull injury as a result of a dog bite, treated at our institution between 1992 and 2010, were identified and analyzed descriptively...

Each year close to 20000 Americans are involved in gunshot wounds to the head (GSWH). Over 90% of the victims of GSWH eventually fail to survive and only a meager 5% of the patients have a chance to continue with a useful life. One of the fundamental jobs of providers is to realize who the best candidate for the best possible management is. Recent evidence indicates that a good Glasgow Coma Scale (GCS) score at the time of admission puts such patients at high priority for management. Lack of abnormal pupillary response to light, trajectory of slug away for central gray, and visibility of basal cisterns upgrade the need for utmost care for such a victim...

Several approaches exist for the treatment of animal attacks targeting the head and neck region. The treatment options and timing vary depending on the animal species, the nature of the defect, and the experience of the surgeon. In this study, early surgical treatment options used in head-neck injuries caused by domesticated or wild animal attacks are presented.We consider 12 patients who were admitted to our clinic between June 2006 and May 2010 with head-neck injuries caused by animal attacks. Tissue defect had developed in 10 patients due to half-wild dog bite and in 2 patients due to wolf bite...

BACKGROUND: Gun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities. METHODS: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed...

OBJECTIVE: To evaluate the clinical characteristics and present the experience in the treatment of patients with penetrating craniocerebral injury (PCCI). METHODS: The data of 7 cases with PCCI by foreign body were retrospectively studied and compared with associated literatures. The strategies of diagnosis and treatment of PCCI were analyzed. In this series, 3 cases underwent emergency debridements and 4 cases underwent craniotomies. All patients received surgical intervention within 3 hours after admission...

The captive bolt gun (slaughterer's gun) is a tool used in the meat industry for "humane killing" of animals. Used with the intent of suicide, the captive bolt gun causes very serious injuries. We analysed 19 self-inflicted head injuries with captive bolt gun during the past 20 years. Autopsy of 20 pigs killed by this method was also performed. All 19 cases were middle-aged men from rural areas, with low level of education, and without a previous psychiatric history. Five of them used the captive bolt gun daily in their professional activities, while the remaining 14 handled it only sometimes...

The Working Party was instituted to investigate the rationale of prophylactic and therapeutic antibiotic use in penetrating craniocerebral injuries (PCCI), and to make recommendations for current practice. A systematic review of papers on civilian and military PCCI over the past 25 and 50 years, respectively, was done via electronic databases and secondary sources, and data were evaluated. Guidelines on the removal of indriven bone or metal fragments only if further neural damage can be avoided were supported...

OBJECTIVE: To determine if head-injured patients with premorbid nasal colonization with Staphylococcus aureus are at increased risk for S. aureus infection. DESIGN: Patients admitted over a 2-yr period were enrolled if they met the following criteria: Injury Severity Score > or = 9, intensive care unit (ICU) admission, hospitalization in another hospital < 24 hrs, no recent use of antibiotics. SETTING: Acute care trauma facility. PATIENTS: Any patient sustaining acute, blunt, or penetrating injury and meeting the enrollement criteria were eligible...

From September 1991 to December 1992, during the war in Croatia, the General Hospital in Slavonski Brod served as an evacuation centre. During that period 197 patients with war-related penetrating craniocerebral injuries were admitted. They were analyzed according to wound characteristics, operability, mortality, operative and post-operative complications, and their condition after hospital discharge and follow-up. A less aggressive surgical approach was accepted in our surgical strategy, recommended in recent studies, followed by an aggressive intensive management...

OBJECTIVE: Traditionally, intracranial pressure (ICP) monitoring has been utilized in all patients with severe head injury (Glasgow coma score of 3-8). Ventriculostomy placement, however, does carry a 4 to 10 percent complication rate consisting mostly of hematoma and infection. The authors propose that a subgroup of patients presenting with severe head trauma and diffuse axonal injury without associated mass lesion, do not need ICP monitoring. Additionally, the monitoring data from ICP, MAP, and CPP for a comparison severe head injury group, and subgroups of DAI would be presented...

During the 1991-1992 war in Croatia, 7,043 wounded persons were treated at Dr Josip Bencević General Hospital in Slavonski Brod. Among them, 728 (580 soldiers and 148 civilians) had war injuries to the head and neck and were admitted to the Department of Otorhinolaryngology and Cervicofacial Surgery. There were 541 (74.3%) patients with head injuries, 117 (16.0%) with neck injuries, and 70 (9.6%) with a combination of head and neck injuries. The wounds were mostly inflicted by shell and bomb fragments (542 wounds, or 74...

The authors used the intracarotid and subarachnoid methods of infusion of antibiotics for treatment of purulent meningitis, brain abscesses. The methods are considered to be fairly effective.

A follow-up study is presented of the initial neurosurgical treatment of 20 patients who sustained penetrating craniocerebral injuries during "Operation Desert Storm". Fifteen of these patients had received intracranial debridement through a craniectomy and five patients had received care of scalp wounds only. Following treatment and stabilisation in a frontline hospital, these patients were transferred to the Riyadh Armed Forces Hospital for further evaluation and management. On admission, all the patients received a computerised tomographic scan which revealed shrapnel fragments inside their brain...

The evidence for and against the prophylactic use of anticonvulsants and antibiotics in head injury is reviewed. There is a lack of blinded placebo-controlled trials in this area. On balance there is no compelling evidence to support the use of either anticonvulsant or antibiotic prophylaxis in head injury, with the possible exception of antibiotic prophylaxis in compound depressed skull fractures and penetrating brain injuries.

We report results of a survey on the management patterns of penetrating head injury (PHI). American neurosurgeons (N = 2969) were asked to participate in a mail survey. One thousand one hundred twenty-eight responded, providing detailed information about their practices, their opinions concerning diagnostic testing, nonoperative therapy, and surgical debridement for PHI. Although there was agreement on some areas of management and care, including the use of computed tomography scanning, antibiotics, anticonvulsants, and a few surgical indications/contraindications, there was wide variation on a significant number of points...